SCALP LACERATIONS
Sufficient hair must be shaved around the wound to allow proper visualisation of all lacerated skin. The scalp edges should be infiltrated with local anaesthetic if the patient's perception of pain is preserved. Then the wound is explored, searching for foreign bodies and for any damage of underlying layers, especially visible fractures, CSF leak or brain debris and also irrigating it with sterile saline. If the damage is considered to be limited to the epicranial tissues, the damaged tissue is debrided to allow closure with minimal tension, and any necrotic parts are removed (Fig. 2-1). Bleeding is often better controlled by coagulation or by bending the galea outwards, rather than by attempting direct clamping of vessels. Excessive tension of the wound edges should be avoided.
Single-layer scalp sutures with approximation of the galea complete the treatment. However, should there be a need to adapt and reduce tension of the edges, the galea should be inverted and interrupted stitches placed. In case of scalp loss, it is possible to control the situation by the undermining or advancement of flaps, sometimes turning them to reduce the skin defect. Any large loss of scalp requires specialised techniques of plastic surgery.